Prior to 1980's, living donation offered the only hope for recovery from end-organ renal failure (1-7]. With improvements in surgical technique [8], organ matching [9-11], rejection treatment [12,13] and organ preservation [14], cadaveric organ donation became the mainstay of transplantation efforts during the late 70's through today [15,15] even though LD graft survival has continued to surpass cadaveric (CD) graft survival [17,18]. Because CD donation became the mainstay of transplantation, national efforts focused on developing and maintaining an equitable distribution system for CD organs for transplantation and increasing CD donation [11,19-21]. Although organ donor rates have improved over the last ten years, the supply of CD organs remains far short of the demand [15, 17] and individual transplant centers are returning to living donation to meet the increasing local needs [22-24]. Despite efforts to increase the LD rate, LD transplants has remained less than 30% for the last 10 years [17]. One explanation for the plateau in the LD rate is that little effort is placed on the organizational and operational processes for identifying, evaluating, and caring for living donors. As the nation turned towards CD donation, l transplant centers the national listing procedures so that CD transplant evaluation and follow-up became the primary model to address transplant candidate and recipient issues, leaving the LD process secondary in individual transplant centers. This secondary approach creates an environment where LD receives less priority and does not systematically address the donors' needs. It is apparent that a new systematic approach to the living donor is needed if transplant centers intend to increase living donor transplantation [22]. This research study will evaluate transplant center and individual barriers and facilitators of living donation. Aim 1 will identify transplant center barriers and facilitators of living donation. Aim 2 will identify individual barriers and facilitators of living donation, and Aim 3 will seek to design a model living donor transplant program.